Care Management Clinician

This is a fully remote position, open to applicants in Florida.

📋 Description

• Support client wellness and independence through advocacy, assessment, planning, communication, education, resource management, and service facilitation.

• Gather and evaluate patient information to create detailed, personalized care management plans.

• Encourage the appropriate use of services and promote cost-effective care.

• Connect clients with suitable providers and resources across health and human services and care environments.

• Ensure that care provided is safe, effective, client-centered, timely, efficient, and equitable.

• Engage in communication with clients, payers, primary care providers, and other professionals involved in service delivery.

• Uphold client privacy, confidentiality, health, and safety through advocacy and compliance with relevant standards and regulations.

• Collaborate with PacificSource staff to ensure high-quality customer service.

• Address medical or contract interpretation inquiries from other departments, physicians, and providers.

• Assist employers and agents with questions regarding healthcare resources and procedures.

• Utilize and advocate for evidence-based tools.

• Apply lean methodologies for ongoing improvement.

• Meet the performance and attendance standards set by the department and company.

• Adhere to PacificSource privacy policies and HIPAA laws and regulations.

• Carry out additional duties as assigned.

• Work within a general office environment; travel is approximately 5% of the time.

⛳️ Requirements

• A minimum of three (3) years of clinical experience, including case management.

• An active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) credential is required.

• Certified Case Manager Certification (CCM) accredited by CCMC is required at the time of hire or within two years of the hire date.

• Familiarity with health insurance and state-mandated benefits.

• Proven experience and expertise in case management practices, including advocacy, assessment, planning, communication, education, resource management, and service facilitation.

• Ability to effectively engage with individuals facing various health issues and concerns.

• Understanding of contractual benefits and available options outside of these benefits.

• Knowledge of community services, providers, vendors, and facilities available to assist members.

• Capability to utilize computerized systems for data entry and retrieval.

• Ability to uphold patient confidentiality, privacy, and the security of health records.

• Skill in building and maintaining relationships with community services and providers.

• Commitment to maintaining current clinical knowledge and certification.

• Ability to work independently with minimal supervision.

• Proficient in reading and understanding written and spoken English.

• Communicate clearly and effectively.

• Capable of stooping and bending; sitting and/or standing for extended periods; performing repetitive tasks such as typing, sorting, and filing; light lifting and carrying.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment that values employee engagement and wellness.